Provider Demographics
NPI:1508810441
Name:DE ANDRADE, GISELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:DE ANDRADE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 7TH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5230
Mailing Address - Country:US
Mailing Address - Phone:212-757-9754
Mailing Address - Fax:646-688-4765
Practice Address - Street 1:850 7TH AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5230
Practice Address - Country:US
Practice Address - Phone:212-757-9754
Practice Address - Fax:646-688-4765
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00644900111N00000X
NY009468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor